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  • Armenia: New Rule For State-Paid Childbirth Stirs Discontent

    ARMENIA: NEW RULE FOR STATE-PAID CHILDBIRTH STIRS DISCONTENT

    EurasiaNet.org, NY
    May 8 2013

    May 8, 2013 - 10:50am, by Gayane Abrahamyan

    A government decree in Armenia that bars pregnant women who are not
    residents of Yerevan from receiving free childbirth services in the
    capital is causing discontent in outlying regions.

    In a bid to boost population numbers, the state covers the costs for
    childbirth services in Armenia. Seeking better facilities and medical
    personnel, pregnant women from the regions often travel to Yerevan
    to give birth. In 2012, 64 percent of the 70,648 women registered
    for state-provided childbirth assistance gave birth in Yerevan,
    according to the National Statistical Service.

    The May 1 decree issued by the Ministry of Health was designed to
    encourage improvements at hospitals in the country's 10 regions. Under
    the measure, women will only be able to obtain state-paid birthing
    services at hospitals in regions where they have an official address.

    Health Minister Derenik Dumanian, the author of the decree, maintains
    that budgetary funds to improve care at public hospitals in regions
    will be forthcoming. The government currently pays 135,000 drams
    ($329) per delivery in Yerevan hospitals, and 97,000 drams ($236)
    at facilities in rural locations.

    "One-third of the pregnant women from the regions come to Yerevan
    to give birth; hence, the money designated for rural hospitals is
    transferred to hospitals in Yerevan, leading to reduced financial
    resources in the regions, as well as an outflow of professionals from
    rural communities to Yerevan," Dumanian told EurasiaNet.org.

    Despite government assurances, some pregnant women from rural areas
    remain wary about the decree. Thirty-three-year-old Gohar Minasian, an
    expectant mother living in Abovian, 16 kilometers outside of Yerevan,
    fears the consequences of giving birth in her local hospital. In 2011,
    she noted, an Abovian anesthesiologist's mistake led to the death of a
    pregnant woman from heart failure. "If this had been in the capital,
    under the supervision of skilled professionals, both the mother and
    the child would have survived," Minasian claimed, without providing
    supporting details.

    Under the decree, pregnant women from the regions will still be able
    to receive free medical care in Yerevan in emergency situations. The
    health ministry's chief obstetrician-gynecologist, Razmik Abrahamian,
    insists that pregnant women in most of Armenia's regions already have
    access to adequate care.

    "If a few years ago we did not have rural maternity hospitals with
    modern facilities and it was understandable why they had to come to
    Yerevan, now six out of the 10 regions have fully equipped hospitals,
    but people keep coming to the capital out of habit," Abrahamian said.

    "The new decree will make them at least familiarize themselves with
    the facilities and conditions available at their new local hospitals,
    and only then make a decision."

    Independent MP Edmon Marukian, who strongly opposes the decree, argues
    that it could end up fueling corruption. "If there are exceptions
    [made to the decree] for high-risk births and [women] will be sent
    to deliver in Yerevan, it is quite possible that women with a normal
    or no-risk pregnancy might bribe someone into getting permission to
    give birth in Yerevan," reasoned Marukian, who represents the northern
    region of Lori. "Or a pregnant woman from a rural community might be
    in Yerevan and need to give birth, but a hospital might check her in
    only in exchange for money."

    Abrahamian dismissed corruption concerns, promising close supervision
    of the decree's implementation. All hospitals have a ministry hotline
    number by which they can report attempted bribery, he added. "Let
    them call and everyone will be punished."

    Based on infant mortality statistics alone, the regions might appear
    a better choice to give birth than a hospital in Yerevan. In 2011,
    the latest year for which data is available, the capital recorded
    118 infant deaths, the highest level in the country. But Abrahamian
    maintained that 70 percent of those deaths were of children born
    to women from the regions, where, he claimed, public knowledge of
    prenatal care is spotty.

    Nationwide over the past decade, the number of infant deaths has
    declined steadily. From 2006-2012, the number of infant deaths per
    1,000 live births dropped by half to 12. The maternal mortality rate
    also has fallen to a just a handful, compared with as many as 35 per
    year a decade ago.

    Senior regional hospital staffers say public perceptions of medical
    care in the regions still lag behind the statistical evidence. For
    example, in Artashat, a town 29 kilometers southeast from Yerevan,
    the birthrate at the local hospital has fallen by 50 percent since
    2008, when the state began paying for childbirth services.

    "Our conditions are good, too, the medical personnel are highly
    professional, but we cannot compete with the hospitals in the capital
    equipped with the newest facilities," said Dr. Zemfira Navasardian,
    head of the Artashat hospital's obstetrics and gynecology department.

    Obstetricians who earlier moved to Yerevan for work may now be tempted
    to return home, hospital executives said, but that process requires
    time. In the meantime, some Armenian women are not willing to wait.

    Barred from state-funded childbirth in Yerevan, Minasian, a
    kindergarten teacher, is saving to pay for the services herself.

    Editor's note: Gayane Abrahamyan is a reporter for ArmeniaNow.com
    in Yerevan.

    http://www.eurasianet.org/node/66943




    From: A. Papazian
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